Principles of Sterile Technique – Gowning & Gloving in the OR

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The principles of Sterile Technique are applied in various ways. If the principle itself is understood the applications of it become obvious. Strict aseptic technique is needed at all times in the Operating Room.

Principles of Sterile Technique

  1. All articles used in an operation have been sterilized previously.
  2. Persons who are sterile touch only sterile articles; persons who are not sterile touch only unsterile articles.
  3. Sterile persons avoid leaning over an unsterile area; non-sterile persons avoid reaching over a sterile field. Unsterile persons do not get closer than 12 inches from a sterile field.
  4. If in doubt about the sterility of anything consider it not sterile. If a non-sterile person brushes close consider yourself contaminated.
  5. Gowns are considered sterile only from the waist to shoulder level in front and the sleeves to 2 inches above the elbows.
    1. Keep hands in sight or above waist level away from the face.
    2. Arms should never be folded.
    3. Articles dropped below waist level are discarded.
  6. Sterile persons keep well within the sterile area and follow those rules from passing:
    1. Face to face or back to back.
    2. Turn back to a non-sterile person or when passing.
    3. Face a sterile area when passing the area.
    4. Ask a non-sterile person to step aside rather than trying to crowd past him.
    5. Step back away from the sterile field to sneeze or cough.
    6. Turn head away from sterile field to have perspiration mopped from brow.
    7. Stand back at a safe distance from the operating table when draping the patient.
    8. Members of the sterile team remain in the operating room if waiting for the case.
    9. Do not wander around the room or go out in the corridors.
  7. Sterile persons keep contact with sterile areas to a minimum.
    1. Do not lean on the sterile tables or on the draped patient.
    2. Do not lean on the nurse’s mayo tray.
  8.  Non-sterile persons — when you are observing a case, please stay in the room until the case is completed. Do not wander from room to room as traffic in the operating room should be kept as a minimum. Patient privacy needs to be respected.
  9. Keep non-essential conversation to a minimum.
  10. The circulating nurse is in charge of the room — if you have any questions, please refer them to her, the supervisor or your instructor. Ask circulating nurse when it is an appropriate time to ask questions so that explanations/rationale can be given.

Sterile Members

Surgeon
The surgeon is “in charge” of the surgical team. He or she is the person who performs the operation and directs the activities of other members of the surgical team. Surgeons usually specialize in the treatment of specific surgical conditions, like orthopedics or cardiac surgery. Becoming a surgeon involves 4 years of college, 4 years of medical school, then 3 to 5 years of specialized residency.

Certified Surgical Technologist
The surgical technologist is responsible for the preparation of the sterile supplies, equipment and instruments, then assists the surgeon in their use. The surgical technologist most frequently serves as instrument handler, setting up the instruments, then “passing” them to the surgeon. Surgical technologists also serve as second assistants, utilizing instruments to perform tasks such as retracting incisions, cutting suture and manipulating tissue. With advanced training or education, some surgical technologists act as first assistants. This role may also be preformed by another physician, a physician assistant or a registered nurse. Becoming a surgical technologist involves 1 to 2 years of college or specialized training.

Non Sterile Members

Anesthesiologist 
The anesthesiologist is a physician who specializes in administering drugs to the patient so he or she is pain free during the operation. They monitor the patient’s response to anesthesia.

Registered Nurse

The Registered Nurse role is generally that of the “circulator”. The circulator is responsible for the patient care during the operation. He or she assesses the patient, assists the anesthesiologist, completes operating room records and dispenses items to the sterile team. Becoming a nurse in the operating room requires 2 to 4 years of college, then specialized training on the job to learn surgical patient care.

Gowning and Gloving

If you are the scrub corpsman, you will have opened your sterile gown and glove packages in the operating room before beginning your hand scrub. Having completed the hand scrub, back through the door holding your hands up to avoid touching anything with your hands and arms. Gowning technique is shown in the steps of figure 2-4. Pick up the sterile towel that has been wrapped with your gown (touching only the towel) and proceed as follows:

  1. Dry one hand and arm, starting with the hand and ending at the elbow, with one end of the towel. Dry the other hand and arm with the opposite end of the towel. Drop the towel.
  2. Pick up the gown in such a manner that hands touch only the inside surface at the neck and shoulder seams.
  3. Allow the gown to unfold downward in front of you.
  4. Locate the arm holes.
  5. Place both hands in the sleeves.
  6. Hold your arms out and slightly up as you slip your arms into the sleeves.
  7. Another person (circulatory) who is not scrubbed will pull your gown onto you as you extend your hands through the gown cuffs.

To gown and glove the surgeon, follow these steps:

  1. Pick up a gown from the sterile linen pack. Step back from the sterile field and let the gown unfold in front of you. Hold the gown at the shoulder seams with the gown sleeves facing you.
  2. Offer the gown to the surgeon. Once the surgeon’s arms are in the sleeves, let go of the gown. Be careful not to touch anything but the sterile gown. The circulator will tie the gown.
  3. Pick up the right glove. With the thumb of the glove facing the surgeon, place your fingers and thumbs of both hands in the cuff of the glove and stretch it outward, making a circle of the cuff. Offer the glove to the surgeon. Be careful that the surgeon’s bare hand does not touch your gloved hands.
  4. Repeat the preceding step for the left glove.

The two techniques of gloving:

  1. Open Gloving
  2. Closed Gloving

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